Irritable Bowel Syndrome (IBS)

Patients with IBS report with abdominal pain and altered bowel habit.

About 15% of the general population have symptoms that justify a diagnosis of IBS; however, only about 20% of these will seek medical opinion, prompting a suggestion of hypersensitivity in them. IBS is the most common single reason for referral to gastroenterologists. In Western series, female patients predominate; in India, most reporting patients are young men, probably only because of social inhibitions in women.

Pain is an important feature of IBS, and is localised to the periumbilical region or lower abdomen, especially the left side. Altered bowel habit is the other symptom. While very few Indian patients have the classical alternating-diarrhoea-and-constipation pattern described from the West, whether diarrhoea or constipation predominates has regional variation even within the country. In patients with constipation, sense of incomplete evacuation is a particularly distressing symptom; since these patients actually have increased attempts at defaecation, they may wrongly be labelled as having diarrhoea and are treated accordingly, with worsening of symptoms. Some of them attempt digital evacuation of the anal canal; these patients often have a profusion of mucus, and may develop ulcers in the canal or lower rectum.

Stool consistency may vary from small-quantity semisolid or liquid with mucus in those with diarrhoea, to hard, pellet-like with mucus in constipated subjects. Blood in stools may take the form of streaks or fresh drops after defaecation; the former are due usually to anal fissures and the latter to haemorrhoids, two conditions these patients are predisposed to.

Abdominal pain or other accompanying features like gas are usually relieved temporarily by defaecation.

Dietary As stated earlier, though the predominant symptoms arise from the colon, up to one-third of patients have accompanying upper gastrointestinal symptoms like dyspepsia, heartburn and bloat. Extraintestinal symptoms like dysmenorrhoea, dysparaeunia, urinary frequency and headache are also common.

Abnormal psychological features have been reported in over 70% of patients; stressful life events are also reported with increased frequency. However, a cause-and-effect relationship is not certain.

Management:

Milk and spicy food may need to be restricted in those with diarrhoea; milk, legumes and cabbage in those with gas bloat. Patients often report relief by eliminating meat from the diet.

High-fibre diets are most effective in patients with constipation; when adequate fibre is already being consumed in the diet with no relief (as often happens in Indian patients), fibre supplementation may be tried.

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